Provider Demographics
NPI:1134736135
Name:DAVIS, JENNAYA LYNN (AGNP-C)
Entity type:Individual
Prefix:MRS
First Name:JENNAYA
Middle Name:LYNN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3102 AMIDON DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-9440
Mailing Address - Country:US
Mailing Address - Phone:336-686-9867
Mailing Address - Fax:
Practice Address - Street 1:509 N ELAM AVE
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27403-1129
Practice Address - Country:US
Practice Address - Phone:336-274-1114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-24
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCDAVI-XGHVT363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health